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ORGANIZATIONAL CULTURE DURING THE ACCIDENT RESPONSE PROCESS* _

D.A. Shurberg and S.B. Heber I 19592 018].64

Brookhaven National Laboratory
Engineering Technology Division
Upton, New York 11973

INTRODUCT I ON

Within our society it has become clear that a nut,ber of organiCarlene exist which
have the potential to cause catastrophes if failure within them was to occur.
Examples of such organizations include chemical plants, airlines, military
organizationm, and nuclear power plants (NPPs). Within thl8 larqer set of
organizations exists a group which places the goal of safety above t_e goal of
productivity. These organizations have been termed "high reliability
organizations'[l]. A distinguishing characteristic of the0e organizations is
that they often lack the ability to learn from their own mistakes because of the
need to avoid failure at ali costs. Thus, these organizations focus on high
performance reliability as opposed to high outcome reliability.

Not all hazardous organizations are necessarily high reliability organizations.

This has been portrayed during accidents such as Chernobyl, Bhopal, Space Shuttle
Challen_er, and Three Mile Island. The question becomes, what made these
organizations different from the countle88 others which engage in similar
operations but have not failed. As part of a larger project looking at the
organizational factors which influence the accident response, the authors have
focused on the issue of organizational culture as a differentiating variable.

THE ACCIDENT RESPONSE PROCESS

Based upon review and analysis of an extensive volume of Nuclear Regulatory

Commission. (NRC) documentation, an observable and definable procee8 for
responding to reactor accidents and emergencies wam identified. Thi, process is
depicted in Figure I and is described in detail elsewhere [2]. Of main interest
here is the fact that this process model i8 characterized by two primary
8trategiesi an anticipatory strategy and an ad hoc strategy.

During the anticipatory strategy, personnel rely on an elaborate set of

procedures which are based on comprehensive analyses and calculations to assist
in the accident response. Under such a strategy the use of well written
procedures provides a viable strategy for mitigation. }Ic_wever, abnormal
situations de have varying degrees of uncertainty and thus the potential for
surprislls ii present. Thus, the ad hoc strategy comes into play. The ad hoc
organizational strategy is utilized when problems develop which have not been
fully anticipated and it relies on the resilience of the organization and the
technology it must manage. While iprocedurei', have been written for every
foreseeable eventuality of NPP operations, the wisdom ,of any particular option
• remains hypothetical until -4.ti8 actually undertaken. Complex and unanticipated
interactions between the various components of a system can occur leading to a
previously unforeseen eventuality.

While a NPP may be faced with the necessity to res|)ond to a situation with either
one or both of these strategies, the NPP must al_o be able to successfully
transform itself from one strategy to the other. It is not clear that the
behaviors and values that would lead, to success within one strategy would lead
tO similar success in the other strategy. It i_ anticipated that different
organizational cultures a_'e needed for success within each strategy as well am

in anticipatory _o an ad hoc strategy., individuals must reconcile those two mete

of beliefs
successful and expectationsfrom
transformation and strategy
one rectify to the
the discrepancies
next. As an in shifts
NPP emphasized
from

'This work was performed under the auspices of the U.$. Nuclear Regulatory

i Commie s ion.

i .... N
,ii DIS"FIRIILgtJTION OF THIS DOOtffvIENq" IS UNLIMITFD
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organizational b ehavlors which exist. In thl8 papor_ the literature and data ar_
used to explore a critical dimension of the accident response process in an NPP:
the transition from an anticipatory strategy to an ad hoc strategy. In
particular, the effect of organizational culture on the implementation of each
of these strategies i8 examined.

ORGANIZATIONAL CULTURE

Organizational culture has been defined as the beliefs, perceptions, and

expectations that individuals have about the organization in which they work and
about the consequences that will follow from one course of action or another.
Consequently, culture ts believed to highly influence behavior within the
organization [3]. A large volume of literature exists which hypothesizem a
direct relationship between organizational culture and organizational
effectiveness [4]. In a 1988 paper by Lengnick-Hall [5] the cultures of
efficiency and innovation were investigated. By drawing a parallel between
efficiency and the anticipatory strategy and between innovation and the ad hoc
strategy, some interesting hypotheses can be formulated as to the types of
culture which would facilitate or impede the organization's success in
undertaking each of the accident response strategies.

The organizational behaviors found [5] to lead to efficiency include shaJ:ed

values, common experiences, and an organizational, versus Job, focus. Thus,
homogeneity of perceived expectations delineating a hierarchical chain of command
and conventional values is hypothesized to be a more critical cultural element
for the anticipatory strategy than for the ad hoc strategy. On the other hand,
organizational innovation appears to be best fostered by open lines of
communication, organizational commitment, job satisfaction, and heterogeneity of
organizational members' skills. Thus, the authors hypothesize that a more team-
work oriented cultural style which de-emphasizes hierarchical levels and
encourages open and collegial communications, is more effective for an ad hoc
strategy.

DATA COLLECTION

To date, the authors have collected data at two NPPs during normal operations and
six NPPs engaged in annual Emergency Preparedness Exercise Inspections.
Additionally, historical documentation (e.g. Emergency Preparedness Exercise
Inspection Re.porto, NRC Integrated Inspection Team Reports) has been reviewed for
relevant insights.

Data collection during normal operation_ has utilized functional analysis,

behavioral observations, and a paper and pencil survey. The behavioral
observations involve the use of a predetermined scheme to capture the behaviors
in which managers engage during their normal working time. The functional
analysis is conducted to understand the roles and responsibilities that variou_
departments and individuals serve within the overall organization as well as the
functional relationships between the departments. Techniques such as structured
interviews, an examination of documentation, walk-throughs, talk-throughs, and
observation of organizational activities are utilized. Finally, a paI_r and
pencil survey package, the Organizational Culture Survey (OCS), has been
compiled, utilizing various survey instruments which tap Issues believed to be
important to high reliability. The S CS includes survey instruments which assess
cultural dimensions and issues related to culture such as commitment to the
organization, cohesion of working groups, coordination of working units, various
aspect8 of communicationm, overall Job satimfaction, the perceived hazardous
nature of work, perception of the importance of safety to success in an
organization, and perceptions concerning environment, safety, and health issues.

Data collected during Emergency Preparedness Exercise Inspections ham relied upon
behavioral observations, both unstructured and using a behavioral checklist
developed for use in the observation of managers during normal operations and
modified for the purposes of the exercise observations. Using the methodology
detailed above for both noz_al operations and Emergency Preparedness Exercise
Inspections, one is able to compare organizations along similar dimensions. The
details of the similarities and differences obtained between the two NPPs studied
during normal operations are documented elsewhere [6]. Presented below are the
relevant differences obtained on the dimensions of organizational culture
hypothesized to be indicative of both the anticipatory and the ad hoc strategies
between the various NPPs observed.

RESULTS

Work conducted by others [7] has suggested that the culture of high reliability
organizations may best be described as placing emphasis on task-related
behaviors. The emphasis on these behaviors is seen by the perceived
organizational expectations of perfectionism, competitiveness, power, and
opposition. Data collected by the authors seems to confirm that similar patterns
aloe exist in NPPs. This finding confirms perceptions held that the NPPs visited
are both "good" performing organizations and therefore can be classified as "high
reliability". One important caveat to this observation is that the data was
collected during "normal" operations which more closely resembles the
anticipatory strategy due to the extensive reliance on procedures. The effect
of such a culture on the operations of NPPB during an ad hoc, emergency type of
situation is not yet known.

Based on the work cited earlier [5] on the cultures of efficiency and innovation,
one would anticipate that the organizational characteristics important to success
using an anticipatory strategy would parallel those necessary for efficiency and
would include a clear hierarchical chain of conunand as well as the exhibition of
more conventional types of behaviors. At one of the NPPs observed during normal
operations, such a pattern was in fact observed. Decision making was pushed up
the chain of command, often residing in the higher authority figures and often
was undertaken in formal, non-collegial settings.

The second NPP, while exhibiting some of the behaviors hypothesized as important
for success under an anticipatory strategy, demonstrated a pattern of results
that more high].y resembled those characteristics suggested as being important for
success in an innovative, or ad hoc, strategy [5]. Open lines of communication,
a more decentralized organizational structure with decisions being made across
all levels within the organization, a greater emphasis on teamwork, and a higher
level of organizational commitment and Job satisfaction were more apparent in
this plant than in the first.

Observations made during the Emergency Preparedness Exercise Inspections provide

further insight on the culture which would best suit success in the ad hoc
strategy. In particular, one of the NPPs at which an exercise was attended
performed more poorly than the others. The communication hines were nok as open
at this NPP as that observed at other plants and this led to confusion among the
exercise participants and the loss of important information. Additionally, a
problem was cited concerning the low heterogeneity of skills within some of the
emergency organization units, which resulted in a reduced pool of available
resources be used for brainstorming and problem solving. Ae noted earlier,
homogeneity of skills and communication patterns which reflect conventional and
hierarchical organizational structures are characteristics of th_ anticipatory
strategy.

CONCLUS IONS

The ability of an organization to effectively move from an anticipatory to an ad

hoc strategy may well depend on the organization having the ability to balance
these two apparently dichotomous cultural styles. The organization which is most
capable of making the necessary transition in an optimal manner may well exhibit
some aspects of both cultural styles during normal operations. Data collected
at one NPP does exhibit this pattern of results, with the organization exhibiting
a clear hierarchical chain of command and perceived conventional behavioral
expectations as well as exhibiting a more decentralized and collegial approach
to uecisionmakin_, a team work orientation, and informal communications. Thus,
 (

it im e_pected that thls organization possesses the capabilities to make a

successful transition from an anticipatory to an ad hoc strategy. Data collected
at a second NPP more strongly exhibits the traditional style suggested as being
important during the anticipatory strategy, with more formal com_nunication8 and
bureaucratically controlled decision-making. This organization may experience
difficulty if faced with the need to make a transition from an anticipatory to
an ad hoc strategy. These conclusions are further validated based on observation
of Emergency Preparedness Exercise Inspections, which suggest that the more
anticipatory types of behaviors actually inhibit successful performance during
an ad hoc response.

The final validation of these hypotheses needs to be demonstrated with cultural

data collected during emergency simulations. The mechanism to obtain such data
during these types of situations is an area for future research.

REFERENCES

I. LaPorte, T.R. and Consollni, P.M., "Working in Practice but not in Theory"
TheoreticAl Challenges of 'High Reliability Organizations'," Journal q_
Public Administrat$on Research and Theory, vol. I, January, 1991, pp. 19-
47.

2. Kramer, J.J. and Heber, S.B., "Responding to Emergencies: How Organization

and Management Make a Difference", in Proceedlnq of the NEA_/CSINI Speqial
Meeting on Accident Management, September, 1991.

3. Haber, S.B., O'Brien, J.N., Metlay, D.S., and Crouch, D.A., _nfluence q_
Organizational Factors on Performance Reliabilit Z, (NUREG/CR-5538), December,
1991.

4. Wilkins, A.L. and Ouchi, W.G., "Efficient Cultures: Exploring the

Relationship Between Culture and Organizational Performance,"
Administrative Sclel!ce__, vol. 28, 1983, pp. 468-481.

5. Lengnick-Hall, C.A., "Fit and Misfit: How to Achieve Efficiency and

Innovation," Or__zat_on DevelQ_ment J o_a__i, vol. 6, Summer, 1988, pp.
67-74.

6. Heber, S.B., Shurberg, D.A., Barriers, M.T., and Hall, R.E., "The Nuclear
Organization and Management Analysis Concept Methodology: Four Years Later, "
in Proceedincls from the 1992 IEEE 5th_9_Cqnference on Human Factors add .power
plants, June 8-12, 1992.

7. Rousseau, D.M., "The Price Of Success? Security Oriented Cultures and

High Reliability Organizations," _nd_etrial crisis Qgarterlv, vol. 3,
1989, pp. 285-302.

DISCLAIMER

]''his rer_rt was prepared .'.isan accounl of work sponsored by an agency of the [ Jnited States
Government. Neithel the United States (;overnn_erlt nor any agency thereof, nor al_y of their
emph_yees, makes any warranty, express t_r implied, or assumes any legal liability or re:,ponsi..
bility for the accuracy, completeness, or usefulness o1 any information, apparatus, pr_:_tuct, or
pr_'ess disclosed, or represents that its use w_.,,uld nol infringe privately .wned Nghts, Refer-
ence herein to any specific commercial pnxtuct, prevc'ess, or service by trade name, trademark,
manufacturer, or otherwise does not necessarily conslitute or imply its endorsement, recom-
mendation, ,Jr favoring by the I.Jnit_J States Government or any agency thereof. The views
and opinions of authors expressed herein do not necessarily state or reflect thos,e of the
United States Government or any agency there_ff.

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Lt is expected that this organization possesses the capabilities to make a
successful transition from an anticipatory to an ad hoc strategy. Data collected
at a second NPP more strongly exhibits the traditional style suggested am being
important du£ing the anticipatory strategy, with more formal communications and
bureaucratically controlled decision-making. This organization may experience
difficulty if faced with the need to make a transition from an anticipatory tc
an ad hoc strategy. These conclusions are further validated based on observation
of Emergency Preparedness Exercise Inspections, which suggest that the more
anticipatory types of behaviors actually inhibit successful performance during
an ad hoc response.

The final validation of these hypotheses needs to be demonstrated with cultural

data collected during emergency simulations. The mechanism to obtain such data
during these types of situations is an area for future research.

REFERENCES

I. LaPorte, T.R. and Consolini, P.M., "Working in Practice but not in Thecry_
Theoretical Challenges of 'High Reliability Organizations', " _ou__._
_ublic Administration Research and TheorY, vol. i, January, 1991, pp. 19-
47.

2. Kramer, J.J. and Heber, S.B., "Responding to Emergencies: How Organization

and Management Make a Difference", in Proceeding of_the NE_.A/CSINI__SDec_!a_
Meetin_ on Accident Manaqem@nt, September, 1991.

3. Heber, S.B., O'Brien, J.N., Metlay, D.S., and Crouch, D.A., n!_u_
O_E_ganizational__.___Factors_
on ......
Performance Rel_, (NUREG/CR-5538), December,
1991.

4. Wilkins, A.L. and Ouchi, _?.G., "Efficient Cultures: Exploring the

Relationship Between Culture and Organizational Performance,"
A dministratlv e Scc ci_!g_e_Q_arter_!X,
c vol. 28, 1983, pp. 468-481.

5. Lengnick-H_ll, C.A., "Fit and Misfit: How to Achieve Efficiency and

Innovation, " .Orqanization_ D_9_Y__-I.
op sept Jour__q;__, vol. 6, Sultmer, 1988, pp.
67-74.

6. Haber, S.B., Shurberg, D.A., Barriere, M.T., and Hall, R.E., "The Nuclear
Organization and Management Analysis Concept Methodology: Four Years Later, "
in P_Eroc___e_ee_ddings
from the 1992 !EEE 5.rh Conference on Human Factors and Power
Plant_______s.,
June 8-12, 1992.

7. Rousseau, D.M., "The Price Of Success? Security Oriented Cultures and

High Reliability Organizations," _ndustrlal crisis Quarter_M, vol. 3,
1989, pp. 285-302.
 . ,,,_

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